Review of "The Anti-Depressant Fact Book"

This book focuses on the newer
antidepressants, especially the selective serotonin reuptake inhibitors
(SSRIs). As its title suggests, it contains many interesting facts. In
particular there are insights about the role of pharmaceutical companies in
controlling information about antidepressants. Breggin has obtained his
awareness through his expert testimony in litigation against the drug
companies.

The book also contains much speculation.
Breggin is inconsistent in this respect as he is sceptical about biological
claims for the effectiveness of antidepressants. He does not always seem to
apply the same degree of rigour to scrutiny of assertions about the risks of
these drugs.

Clearly the
dangers of SSRIs is a topical issue. On June 6, 2001, too late to be included
in Breggin's book, a unanimous jury in Wyoming, USA found that Paxil “can cause
some individuals to commit suicide and/or homicide,” and that it caused Donald
Schell to shoot his wife, daughter, and granddaughter, before turning the gun
on himself. The jury awarded a total of $8 million in damages to the two
families, although the award will be limited to the 80% of “fault” found
against the pharmaceutical company GlaxoSmithKline.

Legal
judgment is not necessarily the same as scientific fact. There is controversy
about the causal role of antidepressants in producing manic switch, akithisia,
suicide and violence. Breggin regards these relationships as facts. Furthermore,
he regards discontinuations reactions, which are increasingly acknowledged to
be problematic, as produced by the recovery of physiological functions
following removal of the drug. However, psychological factors, which he does
not consider, may also be important. The placebo effect in treatment can be
powerful. Hence withdrawing a drug, which is thought to improve mood, may be
expected potentially to cause discontinuation symptoms.

The
overstatement in the book is a pity. It detracts from Breggin's more critical
analysis. For example, it is very valid to point out that brain research has
concentrated on the short-term effects of antidepressants. There has hardly
been any study of the long‑term consequences and whether the brain
recovers from the homeostatic effects of brain change as a reaction to the
presence of antidepressant drugs.

The last
chapter does not contain any facts or speculation about antidepressants.
Instead it describes Breggin's principles of therapy of depression. He focuses
on the importance of relationship and argues for drug‑free therapy.
Certainly there needs to be more of an opportunity for drug-free care and
treatment in mental health practice.

Breggin's
position is principled. He has maintained his independence as a private
therapist since 1968. Although there was overstatement in Toxic Psychiatry, his first book, his humane interest was apparent.
It is still there, but it may be a little battle‑worn through conflict
with pharmaceutical companies that will do virtually
anything to protect their multi-billion dollar drugs. Breggin's bravery should
be acknowledged. Whether he has got the facts about antidepressants correct
remains to be confirmed. I fear he has not got them all right.